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Palmyra man first in Pa. to go home with total artificial heart

When Bob Phillips left the Penn State Milton S. Hershey Medical Center for his Palmyra home this month, he did so without a human heart.

February 5, 2013

Palmyra man first in Pa. to go home with total artificial heart

HERSHEY, Pa. -- When Bob Phillips left the hospital for his Palmyra home this month, he did so without a human heart. The 74-year-old became the first person in Pennsylvania to go home with a total artificial heart and a portable driver to power it, giving him the freedom to wait at home for a human heart transplant.

Last August, an otherwise healthy Phillips suffered a massive heart attack that landed him at Penn State Milton S. Hershey Medical Center, where doctors found nearly complete blockages in arteries to his heart. Two stents were placed to open up the blockages, but an ultrasound procedure found something worse: Phillips’s heart had a large hole between the left and right ventricles and a rupture. The extensive damage couldn’t be repaired.

Doctors used a therapy called extracorporeal membrane oxygenation, or ECMO, to buy Phillips time to decide what he wanted them to do next. ECMO takes over for the heart to give that organ a rest and ensure proper blood flow is maintained to other organs, like the brain, liver and kidneys.

When Bob Phillips left the hospital for his Palmyra home this month, he did so without a human heart. The 74-year-old became the first person in Pennsylvania to go home with a total artificial heart and a portable driver to power it, giving him the freedom to wait at home for a human heart transplant.

Phillips had few options: Conventional surgery could not fix his heart, and the damage was so great that other implants like the more common left ventricular assist device, or LVAD, wouldn’t help him. Doctors told him and his family that because ECMO had kept his other organs healthy, he had one of two options.

“It was total artificial heart or nothing in his case,” said Edward Stephenson, cardiothoracic surgeon, Penn State Hershey Heart and Vascular Institute. “On the spectrum of severity, his heart attack was the highest. Yet on the inside, you wouldn't know he was 70-something because his other organs were so healthy.”

But the total artificial heart would not be without its own challenges. He would have to live attached to an external power source called a driver, and the only FDA-approved version weighs more than 400 pounds, meaning Phillips wouldn’t ever be able to leave the hospital. If he met certain criteria following surgery, and if he and his family underwent extensive training, he might qualify for a clinical trial of a new, much smaller portable driver that would enable his discharge.

“Giving the patient this option to be able to stand up alone and to go get his coffee or newspaper -- even such minor activities of daily living -- it's tremendous."

Either way, Phillips decided to go forward with his only chance at life.

During the five-hour implant procedure, a team of more than 40 surgeons, nurses, anesthesiologists, technicians and transplant coordinators, led by suregons Walter Pae and Stephenson, removed two-thirds of Phillips’s dying heart and attached the two chambers of the total artificial heart made by SynCardia, the only FDA-approved total artificial heart, in its place. Two tubes from the device in his chest exited his abdomen to be connected to the driver that would keep his new heart pumping 24/7.

In October, Medical Center staff helped Phillips celebrate his 74th birthday, followed by Christmas and New Year’s celebrations with the 13-pound Freedom portable driver -- the device that powers his new mechanical heart -- pumping away next to him.

During that time, he and his family were learning how to monitor the device and to fix it if something went wrong at home, such as a kink in the tubes between the driver and the artificial heart, or the inevitable time when an alarm would indicate that one driver must be switched out with another altogether. EMS providers who serve the communities between Phillips’s home town and the Medical Center underwent special training so they could properly respond to Phillips if he had an emergency.

“Giving the patient this option to be able to stand up alone and to go get his coffee or newspaper -- even such minor activities of daily living -- it's tremendous,” said Aly El Banayosy, medical mechanical circulatory support program director, Heart and Vascular Institute. “It's a major step in improving his psychological well-being and recovery and helping him cope with the long waiting time for a donor heart.”

On Monday, Phillips’s wife Norma and their family bid the Medical Center physicians and staff they’ve gotten to know so well goodbye as they escorted Bob Phillips from his room in the Heart and Vascular Institute to a car waiting to take him home for the first time in five months. He wore the Freedom portable driver in a backpack, pushing the backup driver, extra batteries, power cable and all his other equipment in a special cart he will take with him anytime he leaves home.

“It’s an awful lot of stuff to keep track of, so I don’t think I’ll be going too far from home very often,” Phillips said. “But it’s definitely better than the other bigger driver, because I get to go home. It will be nice just to see the place again and get caught up on everything that’s happened while I was away.”

When Bob Phillips left the hospital for his Palmyra home this month, he did so without a human heart. The 74-year-old became the first person in Pennsylvania to go home with a total artificial heart and a portable driver to power it, giving him the freedom to wait at home for a human heart transplant.